OMB control number
Certified Community Behavioral Health Clinic-Expansion (CCBHC-E)
OMB 0930-0402 ยท 0930.
OMB 0930-0402
SAMHSA is requesting clearance for eleven data collection instruments and forms related to the implementation and impact studies to be conducted as part of the evaluation. The evaluation will provide new information about how grants support adoption of the CCBHC model, how grants influence sustainable expansion of CCBHC capacities beyond the grant period, and how implementation of the model influences client-level outcomes. An evaluation of the IA and PDI grantees specifically provides an opportunity to examine implementation successes and challenges within each area of the certification criteria among a larger and more diverse group of clinics operating in different state and community contexts. By carefully measuring that context and how it changes over time, the evaluation can provide new information about how factors such as alternative sources of funding and state/community support for the model can influence implementation and outcomes. Finally, this evaluation has an opportunity to assess changes in quality of care and longitudinal client-level health, behavioral health, and functional outcomes.
The latest form for Certified Community Behavioral Health Clinic-Expansion (CCBHC-E) expires 2028-05-31 and is listed under ICR 202412-0930-003.
Latest Forms, Documents, and Supporting Material
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202412-0930-003 | New collection (Request for a new OMB Control Number) | 2024-12-13 | Approved with change |
OMB Details
Client Interview
Federal Enterprise Architecture: Health - Public Health Monitoring
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form Client Interview | Client Interview | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.